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Functional iron deficiency and diastolic function in heart failure with preserved ejection fraction.
Int J Cardiol 2013; 168(5):4652-7IJ

Abstract

BACKGROUND

Functional iron deficiency (FID) is an independent risk factor for poor outcome in advanced heart failure with reduced EF, but its role in heart failure with preserved EF (HFPEF) remains unclear. We aimed to investigate the impact of FID on cardiac performance determined by pressure-volume loop analysis in HFPEF.

METHODS

26 HFPEF patients who showed an increase in LV stiffness by pressure-volume (PV) loop analysis obtained by conductance-catheterization, performed exercise testing, echocardiographic examination including tissue Doppler and determination of iron metabolism: serum iron, ferritin and transferrin saturation. HFPEF patients who provided ferritin <100 μg/l or ferritin of 100-299 μg/l in combination with transferrin saturation <20% were defined as having FID. In 14 patients the expression of transferrin receptor was determined from available endomyocardial biopsies.

RESULTS

Fifteen out of 26 HFPEF patients showed FID without anemia. Compared to control subjects and HFPEF patients without FID, HFPEF patients with FID showed an up-regulation of the myocardial transferrin receptor expression (p<0.05). No differences between HFPEF patients with and without iron deficiency were found in heart dimensions, systolic and diastolic function obtained by PV-loop and echocardiography analysis. According to the linear regression analysis, LV stiffness was correlated with peak oxygen uptake (r=-0.636, p<0.001) but not with the ferritin level or transferrin saturation. No relation was found between FID and exercise capacity. The association of LV stiffness with exercise performance was independent from the level of iron deficiency.

CONCLUSION

In non-anemic HFPEF patients, cardiac dysfunction and impaired exercise capacity occur independently of FID.

Authors+Show Affiliations

Department of Cardiology and Pneumology, Charité-Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23968714

Citation

Kasner, Mario, et al. "Functional Iron Deficiency and Diastolic Function in Heart Failure With Preserved Ejection Fraction." International Journal of Cardiology, vol. 168, no. 5, 2013, pp. 4652-7.
Kasner M, Aleksandrov AS, Westermann D, et al. Functional iron deficiency and diastolic function in heart failure with preserved ejection fraction. Int J Cardiol. 2013;168(5):4652-7.
Kasner, M., Aleksandrov, A. S., Westermann, D., Lassner, D., Gross, M., von Haehling, S., ... Tschöpe, C. (2013). Functional iron deficiency and diastolic function in heart failure with preserved ejection fraction. International Journal of Cardiology, 168(5), pp. 4652-7. doi:10.1016/j.ijcard.2013.07.185.
Kasner M, et al. Functional Iron Deficiency and Diastolic Function in Heart Failure With Preserved Ejection Fraction. Int J Cardiol. 2013 Oct 12;168(5):4652-7. PubMed PMID: 23968714.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Functional iron deficiency and diastolic function in heart failure with preserved ejection fraction. AU - Kasner,Mario, AU - Aleksandrov,Aleksandar S, AU - Westermann,Dirk, AU - Lassner,Dirk, AU - Gross,Michael, AU - von Haehling,Stephan, AU - Anker,Stefan D, AU - Schultheiss,Heinz-Peter, AU - Tschöpe,Carsten, Y1 - 2013/07/30/ PY - 2013/05/20/received PY - 2013/07/20/accepted PY - 2013/8/24/entrez PY - 2013/8/24/pubmed PY - 2014/8/20/medline KW - CO KW - Diastolic function KW - E/A KW - E/E′ KW - EDPVR KW - EDV KW - EF KW - ESP KW - ESV KW - ET KW - E′/A′ KW - FID KW - HFPEF KW - IVRT KW - Iron deficiency KW - LA KW - LAVI KW - LV KW - LV end-diastolic pressure KW - LV filling index KW - LV mass index KW - LVEDP KW - LVMI KW - PV KW - SW KW - S′ KW - TDI KW - Tau KW - VCO2 KW - VE KW - VO2 KW - VT KW - cardiac output KW - constant of LV stiffness, exponential curve fit to EDPVR KW - dP/dt(max) KW - dP/dt(min) KW - early (E′) to late (A′) diastolic velocity ratio of mitral annulus KW - ejection fraction KW - end-diastolic pressure–volume relationship KW - end-diastolic volume KW - end-systolic pressure KW - end-systolic volume KW - exercise testing KW - functional iron deficiency KW - heart failure with preserved ejection fraction KW - isovolumic relaxation time KW - isovolumic relaxation time constant KW - left atrial KW - left atrial volume index KW - left ventricle KW - maximum rate of LV pressure change KW - minimum rate of LV pressure change KW - peak carbon dioxide output KW - peak oxygen uptake KW - pressure volume KW - ratio of early peak (E) to late peak (A) mitral flow velocities KW - stroke work KW - systolic velocity of mitral annulus KW - tissue Doppler imaging KW - ventilation equivalent KW - ventilatory (anaerobic) threshold KW - β SP - 4652 EP - 7 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 168 IS - 5 N2 - BACKGROUND: Functional iron deficiency (FID) is an independent risk factor for poor outcome in advanced heart failure with reduced EF, but its role in heart failure with preserved EF (HFPEF) remains unclear. We aimed to investigate the impact of FID on cardiac performance determined by pressure-volume loop analysis in HFPEF. METHODS: 26 HFPEF patients who showed an increase in LV stiffness by pressure-volume (PV) loop analysis obtained by conductance-catheterization, performed exercise testing, echocardiographic examination including tissue Doppler and determination of iron metabolism: serum iron, ferritin and transferrin saturation. HFPEF patients who provided ferritin <100 μg/l or ferritin of 100-299 μg/l in combination with transferrin saturation <20% were defined as having FID. In 14 patients the expression of transferrin receptor was determined from available endomyocardial biopsies. RESULTS: Fifteen out of 26 HFPEF patients showed FID without anemia. Compared to control subjects and HFPEF patients without FID, HFPEF patients with FID showed an up-regulation of the myocardial transferrin receptor expression (p<0.05). No differences between HFPEF patients with and without iron deficiency were found in heart dimensions, systolic and diastolic function obtained by PV-loop and echocardiography analysis. According to the linear regression analysis, LV stiffness was correlated with peak oxygen uptake (r=-0.636, p<0.001) but not with the ferritin level or transferrin saturation. No relation was found between FID and exercise capacity. The association of LV stiffness with exercise performance was independent from the level of iron deficiency. CONCLUSION: In non-anemic HFPEF patients, cardiac dysfunction and impaired exercise capacity occur independently of FID. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/23968714/Functional_iron_deficiency_and_diastolic_function_in_heart_failure_with_preserved_ejection_fraction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(13)01410-1 DB - PRIME DP - Unbound Medicine ER -